title: Cost of placement and complications associated with osseointegrated bone-conducting hearing prostheses: a retrospective analysis of medicare billing data.
abstract: OBJECTIVE
  To report the cost of placement and complications related to osseointegrated bone-conducting hearing prostheses (OBHPs) in a Medicare population.
  
  
  METHODS
  We performed a retrospective analysis of nationwide Medicare claims data for operative and nonoperative complications associated with the placement of percutaneous OBHPs between the first quarter of 2007 and the second quarter of 2009 for which there were 6 subsequent quarters of follow-up. We used Medicare Standard Analytical Files (SAF), which contain a 5% random sample of Medicare fee-for-service beneficiaries, excluding those that also were enrolled in a managed-care organization.
  
  
  RESULTS
  We identified 118 patients who had OBHPs placed in the requisite period. Their complication billing data were analyzed for the six-quarters after initial placement. Seventy patients (59%) had no billing codes for complications or repeat procedures after receiving the implant, whereas 48 patients (41%) had such codes. The total adjusted mean cost with repeat/revision operations or complications was $7,812 per patient compared with $6,733 for those without these issues, an increase of $1,079 or 16%.
  
  
  CONCLUSIONS
  We estimate that complications associated with the implantation of percutaneous OBHPs led to $417,616 in additional costs in the entire Medicare fee-for-service population during the study period and that the total cost of placement of these devices together with the cost of their complications totaled $6,789,248. In conclusion, the Medicare SAF database suggests that complications associated with OBHP increased the overall cost of placement by 16%. Like all surgical procedures, these complications and their associated costs should be taken into account when considering treatment options for patients who experience hearing loss.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco; and †Quorum Consulting, San Francisco, California, U.S.A.
authors.forename: Seth E
authors.initials: SE
authors.lastname: Pross
authors.forename: Andrew
authors.initials: A
authors.lastname: Layton
authors.forename: Kuo
authors.initials: K
authors.lastname: Tong
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Lustig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001844:Bone Conduction; D005260:Female; D017048:Health Care Costs; D006310:Hearing Aids / Q000009:adverse effects / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D016348:Osseointegration; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000191:economics*; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult